Rheumatoid Arthritis vs. Osteoarthritis Joint Pain

Rheumatoid arthritis (RA) and osteoarthritis (OA) are two common forms of arthritis but they’re very different conditions. RA is a systemic autoimmune disease in which an overactive immune system attacks healthy cells, and OA is a degenerative disease in which a particular joint is ground down by injury or overuse.

Rheumatoid Arthritis vs. Osteoarthritis

“The pain and progression in each of the diseases are different. They can seem to be somewhat similar in that they both cause pain and decreased function. But then their similarities diverge,” says Mary Ann Wilmarth, DPT, a physical therapist and patient advocate for people with arthritis-related conditions, who is based in the Boston area.

Which is worse? While the general consensus has always been that RA is more debilitating, a study published in Clinical and Experimental Rheumatology reported that “over the last 40 years, pain and functional disability in OA have appeared to be severe and similar to RA.” Other research notes that while the disease burden of OA is similar to that of RA at an initial doctor’s visit, it’s significantly greater at six months, reflecting better treatments for RA.

Understand the Underlying Cause of Joint Pain

Getting relief may feel like the only thing that matters, but in the long run, the root cause of the pain is very important to determine. “The treatments for the two diseases are different,” says Paula Rackoff, MD, rheumatologist and clinical associate professor in the department of medicine at NYU Langone Medical Center in New York City. “You don’t want to miss the opportunity for reversing the inflammatory component of RA. And you don’t want to treat OA with potentially toxic medication if you don’t need it. But every RA patient eventually gets OA as well, so the pain needs to be diagnosed correctly and reassessed every time.”

Look for these differences:

RA It may be first noticed as tenderness and pain along with stiffness in one or more joints. Often, the joints in the hands, wrists, and small joints in the feet are affected first and equally, but not always, on both sides, according to the Johns Hopkins Arthritis Center.

RA is an autoimmune disease with inflammation. Many people also experience fatigue and low-grade fevers. At times the fatigue may be one of the first things that a patient notices, either before or along with the joint pain. Some of the symptoms can wax and wane, including flares.

OA According to the Centers for Disease Control and Prevention (CDC), osteoarthritis pain develops slowly and worsens over time as the cartilage within a joint breaks down and the underlying bones starts to change. It most frequently occurs in the hands, hips, and knees. As the damage to soft tissues in the joint progresses, pain, swelling, and loss of joint motion occurs, notes the National Institute of Arthritis and Musculoskeletal Diseases (NIHAMD). Muscle weakness around a joint may also occur. OA typically affects people over 50, though it can occur in younger people, and women are more likely than men to develop it, according to the Arthritis Foundation.

RA It can affect the entire body or just specific joints, most commonly the hands, wrists, fingers, elbows, knees, feet, and hips. Sometimes what is noticed first is the stiffness in the morning. The synovium, or the lining of the joint, is most affected.

OA It affects only a particular joint, the pain is not symmetrical, and the pain doesn't go away without physical or medical therapy. The joint cartilage is what is worn away. OA can cause different symptoms depending on which joint(s) it affects. As it progresses, it can result in bony growths or spurs (osteophytes) that can further compromise the joints in the fingers. If you have OA in the knee, you might hear a clicking or popping sound when you bend that joint. In the hips, pain may radiate so that you feel it as far as the knee, notes the NIHAMD.

RA Fever, fatigue, hot rash, or joint swelling may occur. With RA, there is systemic inflammation. The eyes, lungs, and heart or circulatory system can also be affected by this inflammation, as well as the skin with rheumatoid nodules. Patients with RA generally have a team of physicians to oversee their treatment of all this different systemic involvement.

RELATED: How RA Can Affect Your Whole Body

OA OA symptoms can vary greatly among patients and OA can make movement and exercise difficult at times. Physical activity, though, is an important part of OA treatment, increasing flexibility and reducing pain, notes the NIHAMD. Lack of exercise can contribute to obesity, which in turn contributes to load, systemic factors, and pain at various levels. The association between obesity and pain is well established, including its bidirectional nature, according to a study published in Osteoarthritis and Cartilage. The Arthritis Foundation points to research showing that losing 1 pound of weight results in 4 pounds of pressure being removed from the knees — losing 10 pounds would relieve your knees of 40 pounds of pressure.

RA The stiffness can last for an hour or more, according to the Johns Hopkins Arthritis Center. Similar stiffness can also happen at other times of the day after long periods of inactivity or sitting.

OA The stiffness generally loosens up within 30 minutes, notes the NIHAMD. Stiffness can occur after sitting or not moving for some time as well.

RA There’s no single test for RA. Medical history, physical examination, imaging tests, and blood tests make up the process.

OA Medical history, physical examination, and imaging tests are used to determine diagnosis. Lab tests may also be done to rule out other forms of arthritis, according to the NIHAMD.

The goal of treatment for both is to improve movement, reduce pain, and minimize joint damage, but the way to that is different for each disease, says Dr. Rackoff. Here's what to expect:

RA The first line of defense is using disease-modifying anti-rheumatic drugs (DMARDs) to reverse chronic inflammation. Anti-inflammatories, pain meds, and physical therapy are also used. It may take some time to determine which medication works optimally for your specific circumstances. A person may even need to try a few different types of medicine or a combination of medications. No two people, even with the same diagnoses, are alike in how they respond to various treatments. It’s a puzzle that has to be put together by you and your doctor, says Dr. Wilmarth. It’s very important to keep an open and honest dialogue with your doctor(s) and healthcare team in general and especially in order to ideally reach and maintain remission with RA.

The goal with RA and other autoimmune illnesses is to treat to target (T2T). This sets remission or low disease activity as a goal. Patients are monitored frequently with their rheumatologist and adjustments to their treatment protocol are made as necessary.

Treating RA early is important in improving outcomes. Guidelines from the European League Against Rheumatism (EULAR) recommend patients see a rheumatologist within 6 weeks after symptom onset.

RELATED: RA: Why Early Treatment Is So Important

OA Treatments include pain meds such as acetaminophen and non-steroidal anti-inflammatories (NSAIDs), and the antidepressant duloxetine (Cymbalta) is approved to treat chronic pain, including OA, notes Mayo Clinic. Strength training, physical therapy and weight loss (if you’re overweight) can also help. Local steroid injections and injections of hyaluronic acid can relieve pain. In the worst cases, joint replacement surgery may be necessary. Research on using collagen injections to rebuild cartilage, especially in the knees, is currently ongoing.